Provider Demographics
NPI:1538141098
Name:CARNOW, MARVIN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:B
Last Name:CARNOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5453 E BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2207
Mailing Address - Country:US
Mailing Address - Phone:323-723-8249
Mailing Address - Fax:323-721-9132
Practice Address - Street 1:5453 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2207
Practice Address - Country:US
Practice Address - Phone:323-723-8249
Practice Address - Fax:323-721-9132
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice